2. SUMMARY. During his trip to Europe, the President
emphasized the importance of G-8 members following through on
pledges on health assistance made at past G-8 summits. The
President also asked for our partners' support for new G-8
initiatives on neglected tropical diseases (NTDs) and
training health workers. The U.S.-EU Summit declaration
endorsed work on both NTDs and health worker training, but
France, Germany, Italy and Canada have been skeptical about
these initiatives. The U.S. Sherpa and Foreign Affairs Sous
Sherpa will continue negotiations on the G-8 Summit texts at
a meeting beginning June 24 in Japan. In order to achieve
our goals at the G-8 Summit, Department requests that
Ambassadors or DCMs reach out to the appropriate Foreign
Affairs and Development Ministry officials to encourage their
support for our health-related priorities for the 2008 G-8.
Posts are requested to report initial replies by COB Monday,
June 24 and should follow-up, as needed. END SUMMARY

HEALTH PRIORITIES AT THE 2008 G-8 IN TOKYO

3. The U.S. has three major goals for the health section of
the G-8 Development and Africa Declaration: to demonstrate
accountability for past G-8 commitments, to support at least
eight partner countries to increase their number of health
workers, and to alleviate the suffering caused by the seven
neglected tropical diseases (NTDs) that can be treated by
mass drug administration: Lymphatic filariasis,
onchocerciasis, schistosomiasis, trachoma, hookworm,
roundworm, and whipworm.

4. The G-8 acceptance of the U.S. goals has been mixed.
While all members agree that the G-8 should deliver on its
past health commitments, there is continued reluctance to
demonstrate how each of our countries and the European
Commission is following through on past commitments. With
regard to health worker training all members agree that it is
important to increase the number of health workers in Africa,
but there is reluctance to commit to specific targets for the
G-8 to assist partner countries to meet. With regard to
NTDs, the G-8 experts have agreed that "efforts to control or
eliminate NTDs need to be reinvigorated." However, there is
as yet no G-8 consensus on addressing specifically the seven
NTDs that can be controlled, or in some cases eliminated,
through mass drug administration per the President's NTD
Initiative. The recent U.S.-EU Summit declaration committed
European Union Member States and the United States to join
together to combat NTDs and to increase the number of health
workers. We believe that these commitments should be pursued
by making specific commitments in the G-8.

ACTION REQUEST

5. To achieve our goals at the G-8 Summit, Department
requests that Ambassadors or DCMs in G-8 countries draw from
the background points in paragraph 7 and reach out to the
appropriate Foreign Affairs and Development Ministry
officials to reiterate the U.S. health-related priorities for
the 2008 G-8 and advocate for their support.

6. Posts are requested to report initial replies no later
than COB Monday, June 24, slugging reply cables to Tierra
Copeland, OES. Additional details and a fact sheet about
NTDs and the President's announcement can be found at
www.usaid.gov/press/factsheets/2008/fs080222. html and
www.whitehouse.gov/news/releases/2008/02/2008 0220.html.
Should post require additional guidance please contact Tierra
Copeland (copelandtl@state.gov) in the Bureau of Oceans,
Environment and Science, Office of International Health and
Biodefense. The Department greatly appreciates post efforts.

BACKGROUND POINTS

7. In making their approaches, Ambassadors or DCMs should
draw upon the following background information:

--- During his visit to Europe, President Bush stressed the
importance of all G-8 members following through on past
commitments, including on health. He also raised U.S. G-8
proposals on NTDs and training health workers. The President
strongly believes that the G-8 must do more to help people
needlessly dying in Africa.

--- First, to maintain G-8 credibility, the G-8 need to build
on progress from prior G-8 Summits and ensure follow-through
on their commitments, including the specific commitments they
made at Heiligendamm on HIV/AIDS, TB, malaria, and polio.
There is, however, no mechanism to monitor performance or
ensure accountability.

--- Second, we believe the G-8 should take specific steps to
help interested partner countries such as Ethiopia and
Mozambique address the severe shortage of trained health care
workers.

--- Our proposal is that the G-8 join us in helping to
support at least eight partner countries to train additional
health workers, as they work toward the WHO goal of 2.3
health workers per 1,000 persons.

--- We are open to your ideas on the number of countries.
The United States and UK have already announced plans to work
in four countries - Ethiopia, Mozambique, Kenya, and Zambia.
Specific targets are critical to ensure measurable outcomes.
We have been surprised by the reluctance of some to accept
mentioning the WHO target of 2.3 health workers per 1000
people as a goal.

--- Third, we have proposed that the G-8 take up the
challenge that WHO Director General Chan delivered at the
World Health Assembly to help the approximately one billion
people who suffer from NTDs: "We now see a whole spectrum of
opportunities that have converged in a most harmonious way.
Safe and powerful drugs are being donated or made available
at very low cost. Integrated approached have been devised
for tackling several diseases at once( With a comparatively
modest, time-limited financial push, many of these diseases
can be controlled by 2015. Some can even be eliminated by
that date."

--- We believe an appropriate and achievable target would be
to work to reach at least 75% of the people affected by seven
major NTDs in the most affected countries in Africa, Asia,
and Latin America.

--- We and the WHO agree that there are seven NTDs that can
be controlled, or in some cases eliminated, if the G-8 and
other donors come together. The President announced in
February an initiative to make a total of $350 million
available over five years to provide integrated treatment of
these seven NTDs to more than 300 million people in the most
affected countries in Africa, Asia, and Latin America.

--- We hope you will be supportive of these initiatives, and
we look forward to working together on this in the final
rounds of negotiations and at the Summit itself in July.

ADDITIONAL BACKGROUND INFORMATION

8. Posts may want to draw from the following background
points on the need for accountability to past G-8
commitments, as appropriate.

--- The Global Fund Board recently approved a decision to
launch a 9th Round of financing at the end of 2008, as part
of an effort to accelerate the response to the diseases. Now
G-8 countries need to support bilateral and multilateral
technical assistance to affected countries to stimulate
quality demand through the development of technically-sound
grant proposals, in accordance with the Fund's model of
country-led, performance-based funding.

--- Provision of technical assistance for the development of
strong national strategies and plans will be essential if the
G-8 countries are to meet their Heiligendamm pledge to commit
$60 billion in aid for health. The USG is working in many
countries to support Global Fund proposal development, and
all G-8 countries should undertake similar efforts.

9. Posts may want to draw from the following background
points on the health workers proposal, as appropriate.

--- There is a severe shortage of trained health care workers
in many developing countries, especially in Africa. In
Mozambique, for example, there are around 600 doctors for a
population of approximately 20 million people. Mozambique
and many other countries fall short of the WHO goal of at
least 2.3 health workers per 1,000 people.

--- On April 17, 2008 the U.S. and UK released a joint
announcement committing to work together on health systems
including health workforce development. We are demonstrating
this commitment in Ethiopia, Kenya, Mozambique, and Zambia.
In these four countries the UK is planning to spend at least
$420 million on health, including the health workforce, over
the next three years, and the U.S. is planning to invest at
least $1.2 billion over five years on health workforce
development.

10. Posts may want to draw from the following background
points on the Neglected Tropical Disease Initiative, as
appropriate.

--- Approximately one billion people, mostly in the
developing world, suffer from one or more NTDs. Most of
these diseases blind, deform, or debilitate their victims.
They can reduce school enrollment, diminish childhood growth
and cognitive development, and reduce economic productivity
in adults.

--- On February 20, 2008, President Bush announced an
initiative to make a total of $350 million available over
five years to provide integrated treatment of seven major
NTDs to more than 300 million people in the most affected
countries in Africa, Asia, and Latin America. This
investment increases the Unites States' commitment to NTDs
from $15 million in 2008 and will expand the targeted number
of countries from 10 in 2008 to approximately 30 by 2013.

--- Treating the millions of people that suffer from NTDs
will bolster child development, promote educational
achievement, and contribute to poverty reduction.
Interventions in fighting these diseases promise large
economic payoffs as they improve educational outcomes and
worker productivity.

--- In her address to the 61st World Health Assembly (WHA)
on May 19, 2008, WHO Director-General Margaret Chan called on
all donor countries, particularly the G-8, to support
President Bush's NTD initiative so it can be funded at $1
billion. Based on WHO estimates, $1 billion would be
required to reach at least 75 percent of the people affected
by these seven major NTDs, in order to enable an 80-90%
reduction from the current burden, with elimination of some
of the diseases after sustained treatment of 3-5 years.

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